1. Field of the Invention
This invention relates generally to electrosurgical instruments, and more particularly to a bipolar electrosurgical cutting instrument specifically designed for use in the performance of percutaneous laparoscopic cholecystectomy procedures.
2. Discussion of the Prior Art
The conventional treatment for a diseased gallbladder has been a total cholecystectomy involving cutting a fairly large incision through the abdominal wall and, using a scalpel, to dissect the gallbladder from its bed and to cut the cystic artery and cystic duct to thereby release the organ and allow it to be extracted through the incision. According to National Inpatient Profile, Healthcare Knowledge Systems, Ann Arbor, Mich., 1989:360, the average postoperative stay following gallbladder removal surgery of this type in 1988, on a nationwide basis, was 6.1 days and full recovery to normal activities required four to six weeks recuperation.
A relatively new procedure referred to as "laparoscopic laser cholecystectomy" has been devised and it is significantly less invasive than the heretofore conventional approach for gallbladder removal. Rather than working through a major incision in the abdominal wall, a first small puncture would is made in the umbilicus. A needle is inserted and a pneumoperitoneum is established with CO.sub.2 gas to distend the abdomen. Next, a trocar and cannula are inserted through the umbilical incision and following removal of the trocar, a 10 mm, 0.degree. diagnostic laparoscope is inserted. Rather than direct visualization through the laparoscope, the scene may be viewed on a CRT screen.
Upon proper observation of the peritoneal cavity, three additional stab incisions are made at predetermined locations and cannulas are inserted. Two of the cannulas may be 5 mm in diameter and the other, 11 mm. The lumens in the cannulas are sufficiently large to permit surgical instruments to be inserted therethrough, the instruments including a grasping forceps, a clip applier for ligating the cystic duct and cystic artery and a microscissors. A flexible, fiber-optic rod coupled to the output of a laser is used to effect hemostatic cutting and vaporization.
While non-contact positioning of the laser fiber may be used for coagulation if hemorrhage occurs, in the event that the bleeder is larger than can be controlled with the laser in its non-contact mode, monopolar cautery is used, with the electrosurgical instrument being inserted through one of the cannulas.
The percutaneous laparoscopic cholecystectomy procedure allows total removal of the gallbladder through the larger cannula and following the surgery, a single stitch in the umbilicus and the use of sterile adhesive strips for closing the other three wounds is all that is required. Using this procedure, the hospital stay has been reduced to less than one day and the period for total recovery and resumption of normal activities is reduced to about four days. Moreover, scarring is minimal.